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Zhang S, Huang S, Tiemuerniyazi X, Song Y, Feng W. A Meta-Analysis of Early, Mid-term and Long-Term Mortality of On-Pump vs. Off-Pump in Redo Coronary Artery Bypass Surgery. Front Cardiovasc Med 2022; 9:869987. [PMID: 35548406 PMCID: PMC9081922 DOI: 10.3389/fcvm.2022.869987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 03/31/2022] [Indexed: 12/15/2022] Open
Abstract
We aimed to compare the early, mid-term, and long-term mortality between on-pump vs. off-pump redo coronary artery bypass grafting (CABG). We conducted a systematic search for studies comparing clinical outcomes of patients who underwent on-pump vs. off-pump redo CABG. We pooled the relevant studies quantitatively to compare the early (perioperative period, whether in hospital or within 30 days after discharge), mid-term (≥1 year and <5 years), and long-term (≥5 year) mortality of on-pump vs. off-pump redo CABG. A random-effect model was applied when there was high heterogeneity (I2 > 50%) between studies. Otherwise, a fixed-effect model was utilized. After systematic literature searching, 22 studies incorporating 5,197 individuals (3,215 in the on-pump group and 1,982 in the off-pump group) were identified. A pooled analysis demonstrated that compared with off-pump redo CABG, on-pump redo CABG was associated with higher early mortality (OR 2.11, 95%CI: 1.54–2.89, P < 0.00001). However, no significant difference was noted in mid-term mortality (OR 1.12, 95%CI: 0.57–2.22, P = 0.74) and long-term mortality (OR 1.12, 95%CI: 0.41–3.02, P = 0.83) between the two groups. In addition, the complete revascularization rate was higher in the on-pump group than the off-pump group (OR 2.61, 95%CI: 1.22–5.60, P = 0.01). In conclusion, the off-pump technique is a safe and efficient alternative to the on-pump technique, with early survival advantage and similar long-term mortality to the on-pump technique in the setting of redo CABG, especially in high-risk patients.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021244721.
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Affiliation(s)
- Shicheng Zhang
- Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Siyuan Huang
- Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xieraili Tiemuerniyazi
- Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yangwu Song
- Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Feng
- Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Sohn SH, Kim SH, Hwang HY, Kim KB. Mid-Term Outcomes and Angiographic Patency of Redo Coronary Artery Bypass Grafting: A Comparison between Off-Pump and On-Pump Surgery. J Chest Surg 2021; 54:106-116. [PMID: 33767030 PMCID: PMC8038887 DOI: 10.5090/jcs.20.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/11/2020] [Accepted: 11/17/2020] [Indexed: 11/18/2022] Open
Abstract
Background We evaluated the mid-term outcomes and angiographic patency of redo coronary artery bypass grafting (CABG). Methods Of 2,851 patients who underwent isolated CABG at Seoul National University Hospital from 2000 to 2017, 88 underwent redo CABG. Patients’ mean age at redo CABG was 66.0±8.0 years. The mean interval between the first-time and redo CABG was 113.0±62.4 months. The mean follow-up duration was 86 months. Early and mid-term clinical outcomes were evaluated. Angiographic patency rates were evaluated early (1–2 days), 1 year, and 5 years after surgery. Comparative analyses between on-pump and off-pump CABG were also performed. Results The culprits for reoperation were previous grafts (65.6%), native coronary vessels (17.8%), and both (16.7%). Off-pump CABG was performed in 75 cases (85.2%), and the mean number of distal anastomoses was 1.8±0.8. The saphenous vein (39.7%) was used most frequently, followed by the right internal thoracic artery (28.4%), right gastroepiploic artery (21.3%), left internal thoracic artery (7.8%), and radial artery (2.8%). Operative mortality was 1.1%. The overall survival, cumulative incidence of cardiac death, and cumulative incidence of major adverse cardiac events were 71.3%,12.0%, and 23.3% at 5 years after surgery, respectively. The overall angiographic patency rates were 95.7%, 90.1%, and 92.2% on early, 1-year, and 5-year angiograms, respectively. The angiographic patency rates of saphenous vein grafts were 93.1%, 85.6%, and 91.3% on early, 1-year, and 5-year angiograms, respectively. No significant differences in clinical outcomes or angiographic patency rates were observed between the on-pump (n=13) versus off-pump (n=75) groups. Multivariable analysis revealed that age (hazard ratio [HR], 1.07; p=0.005) and chronic kidney disease (HR, 3.85; p=0.001) were risk factors for all-cause mortality. Conclusion Redo CABG could mostly be performed using the off-pump technique and did not show increased operative mortality and morbidities.
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Affiliation(s)
- Suk Ho Sohn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Hyun Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ki-Bong Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Tzoumas A, Giannopoulos S, Kakargias F, Kokkinidis DG, Giannakoulas G, Faillace RT, Bakoyiannis C, Doulamis IP, Avgerinos DV. Repeat Coronary Artery Bypass Grafting: A Meta-Analysis of Off-Pump versus On-Pump Techniques in a Large Cohort of Patients. Heart Lung Circ 2021; 30:1281-1291. [PMID: 33810970 DOI: 10.1016/j.hlc.2021.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 02/03/2021] [Accepted: 02/08/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Redo coronary artery bypass grafting (CABG) can be performed with either the off-pump (OPCAB) or the on-pump (ONCAB) technique. METHOD Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), this meta-analysis compared the safety and efficacy of OPCAB versus ONCAB redo CABG. RESULTS Twenty-three (23) eligible studies were included (OPCAB, n=2,085; ONCAB, n=3,245). Off-pump CABG significantly reduced the risk of perioperative death (defined as in-hospital or 30-day death rate), myocardial infarction, atrial fibrillation, and acute kidney injury. The two treatment approaches were comparable regarding 30-day stroke and late all-cause mortality. CONCLUSIONS Off-pump redo CABG resulted in lower perioperative death and periprocedural complication rates. No difference was observed in perioperative stroke rates and long-term survival between the two techniques.
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Affiliation(s)
| | - Stefanos Giannopoulos
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | | | - Damianos G Kokkinidis
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - George Giannakoulas
- Department of Cardiology, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Robert T Faillace
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Christos Bakoyiannis
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Ilias P Doulamis
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Dimitrios V Avgerinos
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York Presbyterian, New York, NY, USA
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Zhang P, Wang L, Zhai K, Huang J, Wang W, Ma Q, Liu D, Gao B, Li Y. Off-pump versus on-pump redo coronary artery bypass grafting: a systematic review and meta-analysis. Perfusion 2020; 36:724-736. [PMID: 33016239 DOI: 10.1177/0267659120960310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background: Redo coronary artery bypass grafting (redo CABG) is associated with increased mortality and morbidity. The aim of this study was to systematically evaluate the evidence comparing the outcomes of off-pump with on-pump redo CABG. Methods: Studies were systematically searched and identified using PubMed, EMBASE, the Cochrane Library, and the International Clinical Trials Registry Platform (ICTRP) by two researchers independently. The primary outcome was 30-day mortality, and the secondary outcomes were in-hospital mortality, post-operative complications, completeness of revascularization, blood transfusion rate, duration of mechanical ventilation, intensive care unit and hospital stays. Results: The 21 studies including 4,889 patients were enrolled in our meta-analysis. Compared with on-pump, the off-pump technique was associated with significantly reduced 30-day mortality (odds ratio [OR] = 0.43, 95% confidence interval [CI] = 0.26-0.72, p = 0.001). Moreover, a notably decreased in-hospital mortality (OR = 0.55, 95% CI = 0.39-0.76, p = 0.0004) and incidence of post-operative new-onset atrial fibrillation, myocardial infarction, acute kidney injury, low cardiac output state, blood transfusion rate (OR = 0.46, 95% CI = 0.35-0.60, p < 0.00001; OR = 0.54, 95% CI = 0.38-0.78, p = 0.0007; OR = 0.51, 95% CI = 0.37-0.70, p < 0.0001; OR = 0.31, 95% CI = 0.20-0.47, p < 0.00001; OR = 0.29, 95% CI = 0.14-0.61, p = 0.001) and significantly shortened duration of mechanical ventilation, intensive care unit and hospital stays (mean difference [MD] = −8.21 h, 95% CI = −11.74 to −4.68, p < 0.00001; MD = −0.77 d, 95% CI = −0.81 to −0.73, p < 0.00001; MD = −2.24 d, 95% CI = −3.17 to −1.32, p < 0.00001) could be observed when comparing the outcomes of off-pump with on-pump redo CABG. There was nonsignificant difference between off-pump and on-pump redo CABG in completeness of revascularization. Conclusion: In patients undergoing redo CABG surgery, the off-pump technique was associated with decreased mortality, less post-operative complications when compared to on-pump.
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Affiliation(s)
- Pengbin Zhang
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
- Laboratory of Extracorporeal Life Support, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Liping Wang
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Kerong Zhai
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
- Laboratory of Extracorporeal Life Support, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Jian Huang
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
- Laboratory of Extracorporeal Life Support, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Weifan Wang
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Qi Ma
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Debin Liu
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Bingren Gao
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Yongnan Li
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
- Laboratory of Extracorporeal Life Support, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
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Rufa MI, Ursulescu A, Nagib R, Shanmuganathan S, Albert M, Reichert S, Franke UF. Off-pump versus on-pump redo coronary artery bypass grafting: A propensity score analysis of long-term follow-up. J Thorac Cardiovasc Surg 2020; 159:447-456.e2. [DOI: 10.1016/j.jtcvs.2019.03.122] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 03/15/2019] [Accepted: 03/26/2019] [Indexed: 11/30/2022]
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Bruno VD, Zakkar M, Rapetto F, Rathore A, Marsico R, Chivasso P, Ascione R. Early health outcome and 10-year survival in patients undergoing redo coronary surgery with or without cardiopulmonary bypass: a propensity score-matched analysis. Eur J Cardiothorac Surg 2018; 52:945-951. [PMID: 28505298 PMCID: PMC5848803 DOI: 10.1093/ejcts/ezx137] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 03/17/2017] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To investigate the in-hospital health outcome and 10-year survival in patients undergoing redo coronary surgery with (redo-CABG) or without (redo-OPCAB) cardiopulmonary bypass. METHODS A total of 349 redo coronary surgery patients were identified from our registry. Of these, 143 redo-OPCAB patients (40.97%) were compared with 206 redo-CABG patients. To minimize the bias, we also conducted propensity score matching. In Matched Analysis A, 111 redo-OPCAB patients with any type of primary cardiac operation were compared with 111 redo-CABG cases. In Matched Analysis B, 84 redo-OPCAB patients with isolated coronary surgery as their primary operation were compared with 84 redo-CABG patients. We assessed for all 3 analyses a composite of in-hospital mortality, acute kidney injury, stroke and severe low cardiac output requiring intra-aortic balloon pump. In addition, we assessed 1-, 5-, and 10-year survival. RESULTS In the unmatched analysis, redo-CABG was associated with higher usage of intra-aortic balloon pump (10 vs 3%, P = 0.01) and composite compared with redo-OPCAB (25 vs 16%, P = 0.06) and similar 10-year survival (67.2 vs 68.5%, log-rank test: P = 0.78). Matched Analysis A showed similar rates of composite (15 vs 21%, P = 0.25) and 10-year survival (65.1 vs 60.8%, log-rank test: P = 0.5). Matched Analysis B showed reduction of the composite (19 vs 8%, P = 0.04), less in-hospital mortality (5 vs 0%, P = 0.13), 4.5 times less need for intra-aortic balloon pump (2 vs 11%, P = 0.02) favouring redo-OPCAB and a similar 10-year survival (71.6 vs 71.7%, log-rank test: P = 0.61). CONCLUSIONS Redo-OPCAB surgery is feasible, safe and effective with improved in-hospital outcome and similar 10-year survival compared to redo-CABG.
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Affiliation(s)
- Vito D Bruno
- School of Clinical Sciences, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Mustafa Zakkar
- School of Clinical Sciences, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Filippo Rapetto
- School of Clinical Sciences, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Asif Rathore
- School of Clinical Sciences, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Roberto Marsico
- School of Clinical Sciences, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Pierpaolo Chivasso
- School of Clinical Sciences, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Raimondo Ascione
- School of Clinical Sciences, Bristol Heart Institute, University of Bristol, Bristol, UK
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Sepehripour AH, Harling L, Ashrafian H, Casula R, Athanasiou T. Does off-pump coronary revascularization confer superior organ protection in re-operative coronary artery surgery? A meta-analysis of observational studies. J Cardiothorac Surg 2014; 9:115. [PMID: 24961148 PMCID: PMC4083864 DOI: 10.1186/1749-8090-9-115] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 06/16/2014] [Indexed: 12/04/2022] Open
Abstract
Off-pump coronary artery bypass surgery (OPCAB) has been hypothesised to be beneficial in the high-risk patient population undergoing re-operative coronary artery bypass graft surgery (CABG). In addition, this technique has been demonstrated to provide subtle benefits in end-organ function including heart, lungs and kidney. The aims of this study were to assess whether OPCAB is associated with a lower incidence of major adverse cardiovascular and cerebrovascular events (MACCE) and other adverse outcomes in re-operative coronary surgery. Twelve studies, incorporating 3471 patients were identified by systematic literature review. These were meta-analysed using random-effects modelling. Primary endpoints were MACCE and other adverse outcomes including myocardial infarction, stroke, renal dysfunction, low cardiac output state, respiratory failure and atrial fibrillation. A significantly lower incidence of myocardial infarction, stroke, renal dysfunction, low cardiac output state, respiratory failure and atrial fibrillation was observed with OPCAB (OR 0.58; 95% CI (confidence interval) [0.39-0.87]; OR 0.37; 95% CI [0.17-0.79]; OR 0.39; 95% CI [0.24-0.63]; OR 0.14; 95% CI [0.04-0.56]; OR 0.36; 95% CI [0.24-0.54]; OR 0.41; 95% CI [0.22-0.77] respectively). Sub-group analysis using sample size, matching score and quality score was consistent with and reflected these significant findings. Off-pump coronary artery bypass grafting reduces peri-operative and short-term major adverse outcomes in patients undergoing re-operative surgery. Consequently we conclude that OPCAB provides superior organ protection and a safer outcome profile in re-operative CABG.
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Affiliation(s)
- Amir H Sepehripour
- Department of Surgery and Cancer, 10th Floor QEQM Building, St Mary’s Hospital, Imperial College London, London W2 1NY, UK
| | - Leanne Harling
- Department of Surgery and Cancer, 10th Floor QEQM Building, St Mary’s Hospital, Imperial College London, London W2 1NY, UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer, 10th Floor QEQM Building, St Mary’s Hospital, Imperial College London, London W2 1NY, UK
| | - Roberto Casula
- Department of Surgery and Cancer, 10th Floor QEQM Building, St Mary’s Hospital, Imperial College London, London W2 1NY, UK
| | - Thanos Athanasiou
- Department of Surgery and Cancer, 10th Floor QEQM Building, St Mary’s Hospital, Imperial College London, London W2 1NY, UK
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Shin YR, Lee S, Joo HC, Youn YN, Kim JG, Yoo KJ. Early and Midterm Outcome of Redo Coronary Artery Bypass Grafting: On-Pump versus Off-Pump Bypass. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2014; 47:225-32. [PMID: 25207219 PMCID: PMC4157472 DOI: 10.5090/kjtcs.2014.47.3.225] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 10/15/2013] [Accepted: 10/16/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Redo coronary artery bypass grafting (CABG) is still associated with increased morbidity and mortality as compared to the first-time operation. Further, the application of the off-pump technique to redo CABG is limited due to technical difficulties. The aim of this retrospective study was to analyze early and midterm results after redo CABG and compare the outcome of redo on-pump and off-pump CABG. METHODS From June 1996 to October 2011, elective redo CABG was performed in 32 patients. Mean age was 64.8 years (on pump 64.3 years vs. off pump 65.5 years; p=0.658), and 21 patients were male. Among these patients, 14 (43.8%) underwent on-pump CABG, and 18 (56.2%) underwent off-pump CABG. RESULTS Internal thoracic artery was used in 22 patients (68.8%), and total arterial revascularization was achieved in 17 patients (53.1%). The average number of distal anastomoses was 2.13, and the rate of incomplete revascularization was 43.8%. The rate of total arterial revascularization was higher in the off-pump group (14.3% vs. 83.3%, p<0.001), and the use of saphenous vein graft was more in the on-pump group (78.6% vs. 16.7%, p<0.001). Overall hospital mortality was 3.1% (n=1) and was comparable in both groups (on pump 7.1% vs. off pump 0%; p=0.249). Postoperative complications occurred in 9 patients (64.2%), and the rate of complications was high in the on-pump group without statistical significance (64.2% vs. 33.3%, p=0.082). The mean follow-up duration was 5.4 years, and overall survival at 10 years was 86.0%±10.5%. There was no significant difference in the 10-year survival rate between the two groups (79.6% vs. 100%, p=0.225). CONCLUSION Redo CABG can be safely performed with acceptable mortality. Redo off-pump coronary artery bypass is feasible with low mortality and morbidity, comparable target vessel bypass grafting, and long-term survival. The off-pump technique might be considered a safe option for redo CABG in high-risk patients.
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Affiliation(s)
- Yu Rim Shin
- Department of Thoracic and Cardiovascular Surgery, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Korea
| | - Sak Lee
- Department of Thoracic and Cardiovascular Surgery, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Korea
| | - Hyun Chel Joo
- Department of Thoracic and Cardiovascular Surgery, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Korea
| | - Young-Nam Youn
- Department of Thoracic and Cardiovascular Surgery, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Korea
| | - Jong Gun Kim
- Department of Thoracic and Cardiovascular Surgery, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Korea
| | - Kyung-Jong Yoo
- Department of Thoracic and Cardiovascular Surgery, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Korea
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Dohi M, Miyata H, Doi K, Okawa K, Motomura N, Takamoto S, Yaku H. The off-pump technique in redo coronary artery bypass grafting reduces mortality and major morbidities: propensity score analysis of data from the Japan Cardiovascular Surgery Database. Eur J Cardiothorac Surg 2014; 47:299-307; discussion 307-8. [DOI: 10.1093/ejcts/ezu081] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Improved Short-Term Outcomes with Off-Pump Reoperative Coronary Artery Bypass Grafting. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2014; 9:49-53. [DOI: 10.1097/imi.0000000000000031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objective Reoperative coronary surgery patients are usually sicker and older, and the procedure is more technically demanding. Comparisons between coronary surgery with (coronary artery bypass [CAB] surgery on cardiopulmonary bypass [CPB]) and without (off-pump CAB [OPCAB]) the pump have been conducted; however, few studies showed results in reoperative cases. We investigate the potential superiority of one technique over the other in redo coronary surgeries. Methods Our institutional Society of Thoracic Surgery database was used to gather the data for 266 isolated reoperative coronary artery surgeries from January 2004 to July 2011. These were divided into the CAB surgery in CPB group (n = 204) and the OPCAB group (n = 62). Results Baseline characteristics of the two groups were similar, except for a significantly higher prevalence of cerebrovascular disease among the off-pump group ( P = 0.01). There was also a trend toward fewer vessels bypassed among the same group ( P = 0.07). Risk adjustment was done using multivariable analyses for detection of independent effects. The use of CPB was an independent predictor of increased rates of postoperative events (odds ratio, 3.9; P = 0.004) and atrial fibrillation (odds ratio, 5.9; P < 0.005) and longer intensive care unit (0.006) and hospital stay (0.004). Conclusions Redo OPCAB seems to offer favorable short-term outcomes compared with redo CAB. Our results suggest a reduced rate of overall postoperative events, decreased new postoperative atrial fibrillation, reduced hours stayed in the intensive care unit, and fewer days stayed from surgery to discharge. This was not associated with an increase in morbidity and mortality. A randomized study with a larger number of patients and with a longer follow-up is needed.
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Ramlawi B, Bedeir K, Garcia-Morales L, Rodriguez L, Reardon M, Ramchandani M. Improved Short-Term Outcomes with Off-Pump Reoperative Coronary Artery Bypass Grafting. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2014. [DOI: 10.1177/155698451400900109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Basel Ramlawi
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX USA
| | - Kareem Bedeir
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX USA
| | | | - Limael Rodriguez
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX USA
| | - Michael Reardon
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX USA
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12
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Sepehripour AH, Saso S, Harling L, Punjabi P, Ashrafian H, Athanasiou T. Does off-pump coronary revascularization reduce mortality in re-operative coronary artery surgery? A meta-analysis of observational studies. Perfusion 2013; 28:340-9. [PMID: 23520171 DOI: 10.1177/0267659113482173] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Re-operative coronary artery bypass grafting (CABG) is a challenging operation that is often performed in a high-risk patient group. Avoiding cardiopulmonary bypass (CPB) in these patients is hypothesised to be advantageous due to the reduced invasiveness and physiological stress of off-pump coronary artery bypass grafting (OPCAB). The aims of this study were to assess whether OPCAB may improve outcomes in patients undergoing re-operative CABG. METHODS Twelve studies, incorporating 3471 patients, were identified by systematic literature review. These were meta-analysed using random-effects modelling. Primary endpoints were 30-day and mid-term mortality. Secondary endpoints were completeness of revascularization, mean number of grafts per patient and the effect of intra-operative conversion on mortality. RESULTS A significantly lower rate of 30-day mortality was observed with OPCAB (OR 0.51, 95% CI [0.35, 0.74]), however, no difference was demonstrated in mid-term mortality. Significantly less complete revascularization and mean number of grafts per patient were observed in the OPCAB group. Meta-regression revealed no change in 30-day mortality when the effect of conversion from one technique to the other was assessed. CONCLUSIONS Off-pump techniques may reduce early mortality in selected patients undergoing re-operative CABG; however, this does not persist into mid-term follow-up. OPCAB may also lead to intra-operative conversion and, although this did not affect outcomes in this study, these results are constrained by the limited data available. Furthermore, OPCAB may increase target vessel revascularization and, consequently, incomplete revascularization which, whilst not reflected in the short-term outcomes, requires longer-term follow-up in order to be fully assessed.
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Affiliation(s)
- A H Sepehripour
- Department of Surgery and Cancer, Imperial College London, UK
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Kara I, Cakalagaoglu C, Ay Y, Al Salehi S, Yanartas M, Anasiz H, Koksal C. Reoperative Coronary Artery Bypass Surgery: The Role of On-Pump and Off-Pump Techniques on Factors Affecting Hospital Mortality and Morbidity. Ann Thorac Cardiovasc Surg 2013; 19:435-40. [DOI: 10.5761/atcs.oa.12.02043] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Raja SG, Amrani M. Reoperative off-pump coronary artery bypass grafting: current outcomes, concerns and controversies. Expert Rev Cardiovasc Ther 2010; 8:685-94. [PMID: 20450302 DOI: 10.1586/erc.10.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Increasing numbers of patients have undergone coronary artery bypass grafting in the last four decades. As a result, the incidence of reoperative coronary artery bypass grafting is rising. Reoperative procedures pose several technical difficulties and are associated with increased operative risks, which exceed those of the initial revascularization. As the incidence of reoperative procedures is increasing so is the experience of reoperative coronary artery bypass grafting, with the resultant evolution of several alternative strategies to lower the operative risks. These strategies include alternative techniques for re-entry, strict avoidance of graft manipulation to minimize the risk of graft atheroembolism, and modification of the method of myocardial protection, depending on the status of the native coronary circulation and the patency of venous or arterial grafts. Off-pump coronary artery bypass grafting is one such technique that, through the avoidance of inherent risks of cardiopulmonary bypass, has the potential to reduce the morbidity associated with reoperative coronary artery bypass grafting. This article evaluates the current outcomes of reoperative off-pump coronary artery bypass grafting, and highlights the concerns and controversies associated with this strategy.
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Affiliation(s)
- Shahzad G Raja
- Department of Cardiac Surgery, Harefield Hospital, Hill End Road, Harefield, London, UB9 6JH, UK.
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Minimally Invasive Direct Coronary Artery Bypass as a Primary Strategy for Reoperative Myocardial Revascularization. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2010; 5:22-7. [DOI: 10.1097/imi.0b013e3181cef8a6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective Conventional reoperative coronary artery bypass grafting is associated with risk of sternal re-entry, injury to patent grafts, and embolization from diseased grafts. Sternal sparing minimally invasive direct coronary artery bypass (MIDCAB) avoids such risks in cases where it is technically feasible. We sought to examine in-hospital outcomes of reoperative MIDCAB surgery. Methods We recorded prospective standardized data from the New York Cardiac Surgical Reporting System database of 369 reoperative MIDCAB cases from 1996 to 2006 and compared with 822 primary MIDCAB patients in the same time period. We compared the preoperative risk profile and postoperative in-hospital outcomes and length of stay for both groups. Results There was a significantly higher risk profile typical of the reoperative patient population (P < 0.001 for stroke, peripheral/cerebrovascular disease, extensive aortic calcification, renal failure, and left ventricular ejection fraction <40%) compared with the primary MIDCAB group. Despite this fact, there was no difference in the in-hospital outcomes and length of hospital stay between the two groups. Conclusions Reoperative MIDCAB provides targeted coronary revascularization and avoids hazards of sternal re-entry, graft injury and manipulation, and deleterious effects of cardiopulmonary bypass. This hastens recovery and provides excellent early outcomes equivalent to primary MIDCAB procedures.
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Balacumaraswami L, Patel NC, Gorki H, Jennings J, Plestis KA, Subramanian VA. Minimally Invasive Direct Coronary Artery Bypass as a Primary Strategy for Reoperative Myocardial Revascularization. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2010. [DOI: 10.1177/155698451000500106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Nirav C. Patel
- Department of Cardiothoracic Surgery, Lenox Hill Hospital, New York, New York USA
| | - Hagen Gorki
- Department of Cardiothoracic Surgery, Lenox Hill Hospital, New York, New York USA
| | - Joan Jennings
- Department of Cardiothoracic Surgery, Lenox Hill Hospital, New York, New York USA
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Mishra YK, Collison SP, Malhotra R, Kohli V, Mehta Y, Trehan N. Ten-year experience with single-vessel and multivessel reoperative off-pump coronary artery bypass grafting. J Thorac Cardiovasc Surg 2008; 135:527-32. [DOI: 10.1016/j.jtcvs.2007.10.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2007] [Revised: 10/05/2007] [Accepted: 10/19/2007] [Indexed: 11/29/2022]
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Tugtekin SM, Alexiou K, Kappert U, Esche H, Joskowiak D, Knaut M, Matschke K. Coronary reoperation with and without cardiopulmonary bypass. Clin Res Cardiol 2006; 95:93-8. [PMID: 16598517 DOI: 10.1007/s00392-006-0335-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2005] [Accepted: 10/14/2005] [Indexed: 10/25/2022]
Abstract
Redo coronary artery bypass grafting (CABG) is still associated with increased morbidity and mortality compared to primary operation. Myocardial protection is one of the key issues in redo on pump CABG and is still a matter of debate. Off pump redo CABG seems to be an attractive alternative as native coronary blood flow remains and cross clamping of the aorta is avoided. The aim of this retrospective study was to compare the outcome of redo CABG with and without CPB. From 1/1998 to 5/2004 redo CABG was performed in 195 patients (pts): 162 male (83.1%) and 33 female (16.9%) pts, age 66 +/- 9 years. In 160 pts, CPB with isolated antegrade myocardial protection was used for redo CABG. Off pump redo CABG was performed in 35 pts (30 male (85.7%) and 5 female (14.3%), age 67 +/- 8 years). Perioperative overall mortality rate was 3.6% (n = 7) and comparable in both groups (on pump 3.8% versus off pump 2.9%; p = 0.90), as well as perioperative myocardial infarction, intraaortic balloon pump implantation rate and secondary morbidity. Complete revascularization was achieved in 139 pts (86.9%) after on pump CABG and in 17 pts (48.6%) of the off pump group (p < 0.01). The average number of grafts was significantly higher in the on pump group (2.8 +/- 0.78 versus 1.6 +/- 0.6; p = 0.04).Furthermore, 20 pts (12.5%) in the on pump group died during follow-up (50 +/- 16 months). Five pts (25.0%) died due to cardiac reasons. In the off pump group 3 pts (8.6%) died during follow-up (44 +/- 13 months), noncardiac related. Overall survival was 83.8% in the on pump group and 88.6% in the off pump group (p = 0.92). On pump redo CABG and off pump redo CABG can be safely performed with low mortality and morbidity. Off pump redo CABG might be limited due to incomplete revascularization.
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Affiliation(s)
- S M Tugtekin
- Dep. of Cardiac Surgery, Heart Center Dresden University Hospital, Fetscherstr. 76, 01307 Dresden, Germany.
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Petrofski JA, Hata JA, Williams ML, Parsa CJ, Thompson RB, Hanish SI, Gehrig TR, Koch WJ, Milano CA. A Gβγ inhibitor reduces intimal hyperplasia in aortocoronary saphenous vein grafts. J Thorac Cardiovasc Surg 2005; 130:1683-90. [PMID: 16308016 DOI: 10.1016/j.jtcvs.2005.01.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2004] [Revised: 12/12/2004] [Accepted: 01/10/2005] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Approximately 50% of aortocoronary saphenous vein grafts are occluded 10 years after coronary revascularization surgery. Intimal hyperplasia, a critical component in saphenous vein graft failure, is defined by vascular smooth muscle cell proliferation, which is mediated in part by betagamma subunits of heterotrimeric G proteins (G(betagamma)) and downstream effectors such as mitogen-activated protein kinases. A peptide consisting of the carboxyl-terminus of the beta-adrenergic receptor kinase (betaARKct) binds G(betagamma), thereby inhibiting G(betagamma) signaling. Utilizing a recombinant adenovirus containing the coding sequence for the betaARKct peptide (AdbetaARKct), this study investigates whether treatment of the vein graft with AdbetaARKct reduces intimal hyperplasia in a large animal model of aortocoronary saphenous vein graft intimal hyperplasia. METHODS Twenty-seven dogs (27-32 kg) underwent aortocoronary bypass grafting to the left anterior descending artery using autologous saphenous vein. Vein grafts were treated with saline (n = 8), an empty adenovirus (n = 8), or AdbetaARKct (n = 8). A subset of dogs (n = 3) were sacrificed on postoperative day 7 and betaARKct expression confirmed by Northern blotting. RESULTS Arteriograms performed on postoperative day 90 confirmed that saphenous vein grafts were patent. At postoperative day 90, AdbetaARKct-treated grafts demonstrated reduced intimal area compared to empty virus and saline treated animals (P < .05). Additionally, AdbetaARKct treatment of isolated vascular smooth muscle cells in vitro inhibited mitogen-activated protein kinase activation and decreased overall vascular smooth muscle cell proliferation. CONCLUSION This study demonstrates that betaARKct expression in aortocoronary saphenous vein grafts reduces intimal hyperplasia and decreases vascular smooth muscle cell proliferation in vitro via inhibition of G(betagamma)-mediated mitogen-activated protein kinase activation. Modulation of G(betagamma) via betaARKct may represent a novel therapy to reduce intimal hyperplasia and saphenous vein graft failure.
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Koronarchirurgische Rezidivoperationen mit und ohne extrakorporaler Zirkulation. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2005. [DOI: 10.1007/s00398-005-0498-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Prondzinsky R, Knüpfer A, Loppnow H, Redling F, Lehmann DW, Stabenow I, Witthaut R, Unverzagt S, Radke J, Zerkowski HR, Werdan K. Surgical trauma affects the proinflammatory status after cardiac surgery to a higher degree than cardiopulmonary bypass. J Thorac Cardiovasc Surg 2005; 129:760-6. [PMID: 15821641 DOI: 10.1016/j.jtcvs.2004.07.052] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Cytokines contribute to the development of the systemic inflammatory response syndrome or multiple-organ failure frequently observed after cardiopulmonary bypass-supported cardiac surgery. To quantify the contribution of bypass-induced versus trauma-induced inflammatory response after coronary artery bypass grafting, we examined plasma cytokine levels in 120 patients with coronary artery disease who were treated with or without cardiopulmonary bypass-assisted procedures. METHODS Patients were treated in accordance with one of the following protocols: (1) elective percutaneous coronary intervention without cardiopulmonary bypass (n = 69), (2) cardiopulmonary bypass-supported percutaneous coronary intervention (cardiopulmonary bypass-percutaneous coronary intervention; n = 10), and (3) cardiopulmonary bypass-supported coronary artery bypass grafting (cardiopulmonary bypass-coronary artery bypass grafting; n = 41). Cytokine levels (picograms/milliliter) were measured by enzyme-linked immunosorbent assay from plasma samples obtained at various time points. RESULTS Interleukin-6 was measured in blood samples from all 3 patient populations. The maximum interleukin-6 level was 13.6 +/- 22.3 pg/mL in the percutaneous coronary intervention group, 170.4 +/- 165.4 pg/mL in the cardiopulmonary bypass-percutaneous coronary intervention group, and 640.3 +/- 285.7 pg/mL in the cardiopulmonary bypass-coronary artery bypass grafting group. Interleukin-6 levels were significantly different, and the 95% confidence intervals did not overlap. In the cardiopulmonary bypass-percutaneous coronary intervention group, bypass duration correlated well with interleukin-6 production ( r = 0.915; P < .001), whereas these parameters did not correlate in patients who underwent cardiopulmonary bypass-coronary artery bypass grafting ( r = 0.307; P = .054). CONCLUSIONS These findings support the suggestion that surgical trauma and cardiopulmonary bypass contribute to the inflammatory response after cardiac surgery, although trauma may contribute to a higher degree.
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Affiliation(s)
- Roland Prondzinsky
- Department of Medicine III, Martin-Luther-University Halle-Wittenberg, Halle (Salle), Germany.
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Machiraju VR. Redo Cardiac Surgery. J Card Surg 2004. [DOI: 10.1111/j.0886-0440.2004.4050_11.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
BACKGROUND Reoperative coronary artery bypass grafting (CABG) has been associated with higher mortality and morbidity than first-time CABG. Off-pump surgery has been introduced in an effort to reduce morbidity associated with traditional on-pump CABG. However, these techniques present unique challenges in the reoperative setting. A review of our experience was undertaken to determine safety, efficacy, and technical challenges in beating heart reoperative CABG. METHODS From January 1999 through April 2003 reoperative CABG procedures performed by a single surgeon were treated on an "intention to treat" basis without cardiopulmonary bypass. A standardized operative technique employing suction stabilization and exposure devices were used for sternotomy procedures with stabilization devices employed for limited access single-vessel revascularization. RESULTS Eighty-six of eighty-seven (99%) consecutive patients undergoing reoperative CABG had the procedure initiated off-pump. There were 24 of 62 females/males (28%/72%) with a mean age of 64.3 (34 to 92). Eighty-one of eighty-six (94.2%) procedures were successfully completed off-pump. Five (5.8%) conversions were due to hemodynamic instability, inability to dissect dense adhesions (2), inability to locate an intramyocardial LAD (1). The procedures were performed via a median sternotomy in 67 patients (78%) and by limited anterior or lateral thoracotomy in 19 patients (22%). The operative mortality was 2 of 86, predicted risk 6.7%. There was no mortality in the converted patients. Postoperative length of stay was 5.5 days. There were no strokes or perioperative myocardial infarctions. Complications included reoperation for bleeding in 2.2%. Sixty-one of sixty-six (92.4%) patients were able to be extubated in the operating room. The rate of transfusion was 23 in 86 patients (26.5%), and atrial fibrillation was 5 in 86 patients (5.8%). CONCLUSION Off-pump CABG can technically be performed safely in most patients presenting for reoperative CABG. Outcomes appear to be improved compared with published outcomes of reoperative on-pump CABG surgery.
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Affiliation(s)
- Michael J Mack
- Cardiopulmonary Research Science and Technology Institute, Dallas, Texas 75230, USA.
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Abstract
OBJECTIVE Despite advances in cardiac surgery, the risk of reoperative coronary artery bypass surgery (RECABG) still exceeds those of a primary myocardial revascularization and also the late results are not so favourable. In this study, long-term cardiac survival is analyzed. METHODS We analyzed long-term cardiac survival of 466 patients who survived the first 6 months after a RECABG between January 1987 and December 1998. Actuarial survival estimates were calculated and pre- and peroperative variables were analyzed to identify predictors of long-term cardiac related mortality. RESULTS Mean follow-up was 7.7 +/- 3.8 years (1-17 years), and follow-up was 95.6% complete. One-year cardiac survival was 98.2%, 5-year: 91.0%, 10-year: 78.7% and 14-year survival 60.2%. Cardiac survival was only significantly superior for patients under 65 years of age at the moment of the RECABG. Impaired left ventricular function was identified as the only independent predictor of late cardiac-related mortality. CONCLUSION The long-term survival in patients undergoing RECABG is acceptable. Once patients survived the first 6 postoperative months, advanced age (>65 years) is affecting long-term cardiac survival and impaired left ventricular function is the only independent predictor of late cardiac mortality.
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Affiliation(s)
- Luc Noyez
- Department of Thoracic and Cardiac Surgery, 414, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
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Abstract
Patients presenting with recurrent symptoms after coronary artery bypass graft surgery (CABG) continue to be a significant therapeutic challenge for the interventional cardiologist and cardiac surgeon. Percutaneous transcatheter angioplasty and repeat CABG, directed at vein graft degeneration and progression of native atherosclerotic disease, carry substantially worse outcomes than primary procedures. Recent minimally invasive, surgical advances using minimal-access incisions, arterial conduits, and off-pump techniques are demonstrating improved hospital outcomes compared with conventional CABG. These sternotomy-sparing, beating heart surgical approaches combined with recent advances in drug-eluting stents to provide complete revascularization may provide the best cardiac event-free survival for symptomatic CABG patients in the future.
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Affiliation(s)
- Mark W Connolly
- Department of Cardiovascular and Thoracic Surgery, Cathedral Heart & Vascular Institute, St. Michael's Medical Center, Newark, NJ 07102, USA.
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